Current relevance of cervical ultrasonography in staging cancer of the esophagus and gastroesophageal junction

Schreurs, Liesbeth; Verhoef, Christian; Jagt, Erik J. van der; Dam, Gooitzen M. van; Groen, Henk; Plukker, John

doi:10.1016/j.ejrad.2007.06.022

Cited by 15 publications

(9 citation statements)

References 19 publications

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“…consisted of patients with squamous cell carcinoma of the head and neck instead of adenocarcinomas of the distal esophagus and gastroesophageal junction, of which our cohort mainly consists 19 . A study of 180 patients with esophageal carcinoma showed no additional value of ultrasonography since all nodal metastases were detected by side‐by‐side evaluation of PET and CT, which is in agreement with the results of our study, although we performed integrated PET‐CT scanning 20 . Omloo et al .…”

Section: Discussionsupporting

confidence: 89%

External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography-computed tomography (PET-CT) scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma

Blom

Vliegen

Schreurs

et al. 2011

Diseases of the Esophagus

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One of the objectives of preoperative imaging in esophageal cancer patients is the detection of cervical lymph node metastases. Traditionally, external ultrasonography of the neck has been combined with computed tomography (CT) in order to improve the detection of cervical metastases. In general, integrated positron emission tomography-computed tomography (PET-CT) has been shown to be superior to CT or PET regarding staging and therefore may limit the role of external ultrasonography of the neck. The objective of this study was to determine the additional value of external ultrasonography of the neck to PET-CT. This study included all patients referred our center for treatment of esophageal carcinoma. Diagnostic staging was performed to determine treatment plan. Cervical lymph nodes were evaluated by external ultrasonography of the neck and PET-CT. In case of suspect lymph nodes on external ultrasonography or PET-CT, fine needle aspiration (FNA) was performed. Between 2008 and 2010, 170 out of 195 referred patients underwent both external ultrasonography of the neck and PET-CT. Of all patients, 84% were diagnosed with a tumor at or below the distal esophagus. In 140 of 170 patients, the cervical region was not suspect; no FNA was performed. Seven out of 170 patients had suspect nodes on both PET-CT and external ultrasonography. Five out of seven patients had cytologically confirmed malignant lymph nodes, one of seven had benign nodes, in one patient FNA was not performed; exclusion from esophagectomy was based on intra-abdominal metastases. In one out of 170 patients, PET-CT showed suspect nodes combined with a negative external ultrasonography; cytology of these nodes was benign. Twenty-two out of 170 patients had a negative PET-CT with suspect nodes on external ultrasonography. In 18 of 22 patients, cervical lymph nodes were cytologically confirmed benign; in four patients, FNA was not possible or inconclusive. At a median postoperative follow-up of 15 months, only 1% of patients developed cervical lymph node metastases. This study shows no additional value of external ultrasonography to a negative PET-CT. According to our results, it can be omitted in the primary workup. However, suspect lymph nodes on PET-CT should be confirmed by FNA to exclude false positives if it would change treatment plan.

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Section: Discussionsupporting

confidence: 89%

External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography-computed tomography (PET-CT) scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma

Blom

Vliegen

Schreurs

et al. 2011

Diseases of the Esophagus

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“…Der isolierte Befall zervikaler Lymphknoten ist beim Magenkarzinom eine Rarität [281]. Die B-Bild-Sonografie ist der Computertomografie im Nachweis von Halslymphknotenmetastasen gleichwertig oder geringfügig überlegen [282][283][284][285] und daher ergänzend sinnvoll, wenn nicht bereits im Rahmen der CT-Untersuchung eine Beurteilung der zervikalen Lymphknotenstationen erfolgt ist. Die ultraschallgestützte Feinnadelaspirationsbiopsie ist geeignet, den metastatischen Lymphknotenbefall histologisch zu sichern [283,[286][287][288].…”

Section: Hintergrundunclassified

S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL

Moehler¹,

Al-Batran²,

Andus³

et al. 2019

Z Gastroenterol

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“…PET has shown additional value for preoperative lymph node staging, mainly by an increased detection of distant nodal metastases [17, 18]. Only 1 study has been performed which stated that PET and/or CT can replace external US for the specific detection of suspected cervical lymph nodes [19]. However, in the present analysis, PET did not improve the detection of involved lymph nodes in the neck.…”

Section: Discussionmentioning

confidence: 54%

Additional Value of External Ultrasonography of the Neck after CT and PET Scanning in the Preoperative Assessment of Patients with Esophageal Cancer

Omloo¹,

Heijl²,

Smits³

et al. 2009

Dig Surg

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Introduction: Lymphatic dissemination of a (non-cervical) esophageal tumor to the neck is generally considered as distant metastasis. The aim of this study was to determine the additional value of external ultrasonography (US) to detect lymphatic metastasis to the neck after normal CT scan (CT) with or without normal PET scan (PET). Methods: Between January 2003 and December 2005, 306 patients were analyzed for esophageal cancer in our department. A total of 233 patients underwent both CT and external US of the neck. PET was performed in 109 of these patients as part of a prospective cohort study. Fine needle aspiration (FNA) was only performed if external US reported suspected lymph nodes. FNA was defined as gold standard. Results: In 176 patients (76%), CT did not identify any suspected nodes, but external US disagreed in 36 of them. In 9 of these patients, FNA confirmed metastasis, resulting in an additional value of external US after normal CT scanning of 5% (9/176). In 74 patients (68%), CT and PET did not identify any suspected nodes, but external US disagreed in 11 of them. In 3 of these patients, FNA confirmed metastasis, resulting in an additional value of external US after normal CT and PET of 4% (3/74). Conclusion: Considering its minimal invasiveness and wide availability in combination with the importance of the potential therapeutic consequences, we conclude that external US of the neck should be part of the routine diagnostic work-up in patients with esophageal cancer, even after normal CT and PET scanning.

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Current relevance of cervical ultrasonography in staging cancer of the esophagus and gastroesophageal junction

Cited by 15 publications

References 19 publications

External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography-computed tomography (PET-CT) scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma

External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography-computed tomography (PET-CT) scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma

S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL

Additional Value of External Ultrasonography of the Neck after CT and PET Scanning in the Preoperative Assessment of Patients with Esophageal Cancer

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